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目的:评价国产小腰大边封堵器封堵多出口膜部瘤型室间隔缺损(VSD)的可行性、安全性和疗效。方法:选择69例多出口膜部瘤型VSD患者,经左心室造影证实右心室面均有多个出口。其中29例患者选用普通对称封堵器进行封堵(A组);40例患者选用小腰大边封堵器进行封堵(B组)。2组患者分别根据膜部瘤大小、形态、位置及膜部瘤组织粘连牢固程度,置入相应型号的普通对称封堵器或小腰大边封堵器,封堵后15min重复左心室造影和经胸超声心动图检查(TTE),观察封堵的即刻效果。术后连续心电监护5d。2组患者均于术后1、3、6个月定期心电图、TTE检查。结果:A组成功封堵19例,术中并发左、右束支传导阻滞各1例,1例术后造影示少量残余分流(<3mm),1个月后超声复查无残余分流,另10例因封堵器未能完全覆盖多发缺损口或封堵器引起心室流出道狭窄而换用小腰大边封堵器封堵成功;B组40例患者均一次封堵成功,3例术后造影示少量残余分流(<3mm),1个月后超声复查无残余分流,术中并发左、右束支传导阻滞分别为3例和2例。结论:经导管应用国产小腰大边封堵器封堵多出口膜部瘤型VSD疗效可靠,成功率高,并发症少,与普通对称封堵器相比有明显的优势。
OBJECTIVE: To evaluate the feasibility, safety and efficacy of domestic small lumbar and large occluder occlusion of multiple outlet tumor of ventricular septal defect (VSD). Methods: Sixty-nine patients with multiple myeloma type VSD were selected. Left ventricular angiography confirmed that there were multiple exits in the right ventricular surface. Among them, 29 patients were treated with common symmetrical occluder (group A) and 40 patients with small occluder (group B). According to the size, shape and location of membranous tumor and the firmness of membranous tumor, the two groups of patients were placed into common symmetrical occluder or small-sized occluder of small lumbar. The left ventricular angiography was repeated 15min after occlusion Transthoracic echocardiography (TTE) was performed to observe the immediate effect of occlusion. Continuous ECG after 5d. The patients in both groups had regular electrocardiogram and TTE at 1, 3 and 6 months after operation. Results: In group A, 19 cases were successfully blocked, 1 case had left and right bundle branch block in operation, 1 case showed residual residual shunt (<3mm) after operation, and no residual shunt after 1 month. 10 cases of closure due to failed to completely cover the multiple defect or occlusion caused by ventricular outflow tract stricture and switch to a small occlusion of a large occlusion of the waist was successful; B group of 40 patients were successfully blocked, 3 cases of surgery Postoperative angiography showed a small residual shunt (<3mm). One month later, there was no residual shunt after ultrasound. The left and right bundle branch block were 3 and 2 respectively. CONCLUSION: The transcatheter closure of multi-outlet VSD with a small small-to-large side occluder has the advantages of reliable curative effect, high success rate and few complications. Compared with the common symmetrical occluder, it has obvious advantages.